Anesthesia Coding Alert

Question: Our anesthesiologist performs a flat-fee procedure called acute normovolemic hemodilution. Is there a billable CPT code for this?

Colorado Subscriber  
Answer: Normovolemic hemodilution is used to minimize blood loss during surgery. At the start of the procedure, blood is removed from the patient (usually one to three units) and is replaced with either colloid or crystalloid. Because the blood is replaced in the intravascular space, the technique is called isovolemic or normovolemic hemodilution.
 
The loss of blood makes the patient anemic. During surgery, the patient loses this anemic blood, rather than blood rich in red cells. At the end of the procedure, the patient is transfused with his or her blood that was removed prior to surgery. Normovolemic hemodilution can reduce the need for transfusions and is often used by patients whose religion may discourage other methods of transfusion.
 
Hypervolemic hemodilution is another technique. In this procedure, anemia is induced not by blood removal but solely by hemodilution, sparing the patient blood loss. After surgery, the excess fluid is eliminated as urine. Invasive lines, such as A-lines and central venous pressures, are often placed in patients who undergo these procedures. Line placements are not included in the global anesthesia fee and are billable separately by the anesthesiologist.
 
Billing for normovolemic hemodilution is tricky. A code for the procedure is not included in CPT 2001, but the ASA Relative Value Guide (RVG) recognizes it as a four-unit modifier 01980 (acute normovolemic hemodilution > 10% of estimated blood volume). If your carrier doesnt use the ASA-RVG guidelines, you can bill the technique for individual consideration by the carrier (some insurers use the term by report only) or as an unlisted procedure. If you are unsure, ask your Medicare carrier and private insurers for their advice on coding and billing this procedure.